10 Aug 11 28 Nov 16

A letter from Liben, Ethiopia.

Alice Gude is a British nurse working with Médecins Sans Frontières/Doctors Without Borders (MSF) in Liben, Ethiopia.  Here she shares her first-hand account of the crisis facing Somalis.  For more information on the situation in Somalia and how to donate please click here.

Hello All,

Greetings from a VERY dusty Somali Region.  I would have liked to have emailed sooner but as I am sure you have heard on the news, it has been a difficult time.  The start of the situation was apparent from March but it has grown in proportions that I could not have imagined. 

[video: http://www.youtube.com/watch?v=c3IelAATXBM]

I have seen this project expand from the beginning of March to a situation which is tragic beyond means.  We have been receiving up to 1,000 refugees across the border on a daily basis.  The two original camps are double their original capacity at 40,000 each and the third camp has reached full capacity of 24,000 in 3 weeks, a total of 104,000 in the camps with another 14,000 at the border.  We now have 9,500 children in our programme, 200 children in our two inpatient facilities, countless support staff, approximately 120 nurses and 40 expats. 

This week I have finally completed the Community Health Worker recruitment and I now have three teams totalling 150 refugees.  This was a lot of exams and interviews!  We are still squashed into our MSF compound but logistics are making amazing advances in expanding our existing structures and luckily our compound too. 

People are dying in Somalia.

The emergency team has been like fire ball angels. They are hard and fast and cut throat but they have come with vision and most of all resources. It has been the most incredible experience to have gone from feeling like I was yelling in a vacuum to suddenly things moving and happening.

The condition for the refugees is dire. This is the worst drought that Somalia has seen for many years. People are dying in Somalia.  Their crops have failed for many seasons and their livestock are all dying. They are coming from many regions and they travel for 12-16 days of walking to get to the border with minimal food or water.

At some point, the influx was severe and the border pre-registration was unable to cope with the sheer numbers of people. Water was scarce, food and shelter non-existent. They are then moved to the transit centre where the conditions again are poor and are finally moved to the camps, which are still not ready for full capacity. The total journey takes approximately 6 weeks which is enough to destroy the most hardened of Somali people yet alone children. Many families had stories of children and adults dying at some point on the journey to the camps. 

Nurse Alice Gude
It is special to see the reaction of the mothers...once they realise the child will survive.

The state they arrive in is shocking: you get used to seeing skinny children but it gets me when they have the look of an old mans face, typical of marasmus or when they stand up they have a bottom similar to an elephant, with folds of skin and no cheekiness about it. It breaks my heart.

The saddest thing is to hear the refugees’ distress when they arrive and realise that the response is still slow in preparation for these arrivals. It is especially hard to see the many children who come to our service in such a bad way that there is very little we can do for them.  20% would be in an ICU if there were in Europe, knocked out and on a machine to allow their bodies to heal.  A number of them have died but sometimes they surprise you completely and recover and to see a child that was skin and bones to then smile and eat on their own is amazing.  It is special to see the reaction of the mothers go from complete desolation that comes across as disinterest to their joy and love they show once they realise the child will survive.

There has been some reorganisation and I was appointed Community Outreach. At first it was difficult to cut my ties with the nurses but it has evolved (as I knew it would) to be the best job in the whole project.  I have a local nurse supervising 50 Community Health Workers in each camp and we are able to start making a strong and effective service.  Some of my team are fantastic and the most enthusiastic, interesting and motivated people I have ever worked with.  It is so wonderful to work so closely with the refugees themselves and to have full access to all the camps, talking to them, hearing their concerns and sadly witnessing the appalling conditions they live in. 

Sometimes I get fed up...but then I feel embarrassment.

The majority of the population is women and children. When women refuse admission to the inpatient facility as they have 4 other children and no-one to care for them you can understand their distress.  When you ask why they share the plumpy nut (the fortified high energy food we provide to the malnourished children) and they reply they have 4 other children with nothing to eat it is hard to give a sensible reply.

The emergency team has also brought an anthropologist to work with me in Outreach.  He has many years of experience and is a delight to work with.  We have a great strategy set up to really strengthen and improve our outreach team for long term benefit of the programme here, including many shelters in the camps to provide discussion and health promotion.  It is great to be able to provide these services for the CHWs and make their work easier and more enjoyable We are looking for a donkey ambulance to service the camps too!  Sounds silly but in practice will be highly effective to bring the severely sick children to our structure.

I am sure there are so many more things to tell and I hope this has given you a glimpse into the world I live in at the moment.

Sometimes I get fed up with minimal water, red spaghetti every night and working 7 days a week and then I feel embarrassment as I remember that it is a whole world better than wheat and dust, no water and no shelter.

It would be stupid to end this email without asking that if you have any desire to donate to the plight of the Somali people then I would thoroughly recommend you donate to MSF. I can honestly say proudly that what the MSF emergency team are achieving here and providing in this desolate situation is definitely something to be proud of.

So I will leave you with that.

Thanks for listening and hope you are all well.

Thanks to all,


Please click here to donate to our Somalia appeal.